Sen. Grace Poe urged the Commission on Audit (COA) to release the 2020 Audit Report on the Philippine Health Insurance Corp. (PhilHealth) to give legislators a clear picture of the state of its finances while discussion on the 2022 national budget is ongoing.
“We need to know exactly how much PhilHealth owes hospitals and healthcare workers. They must be paid soon and government must figure out where to get the funds,” Poe said.
The senator pointed out that the COA report will render a credible audit of PhilHealth’s financial condition and see to it that funds are effectively used for the people’s health services needs.
“The operations of hospitals are at risk. We are still in a pandemic and people are still dying. PhilHealth must not hide or sugarcoat its numbers,” Poe added.
In COA’s 2019 Annual Audit Report on PhilHealth, benefit claims have totalled P75.57 billion, close to double the P39.79 billion benefit claims reported at the end of 2018.
The Private Hospitals Association of the Philippines Inc. (PHAPi) said they are still awaiting PhilHealth’s action to pay the COVID-19 claims from 2020 even as some hospitals said they are contemplating not renewing their accreditation.
“This will make it difficult for PhilHealth members to reap the full benefits of their membership as they will have to pay for their medical expenses from their own pockets and hope that the state health insurer will reimburse them,” Poe said.
“PhilHealth cannot resort to delaying and scare tactics to discourage hospitals from pursuing what’s due them,” Poe added after PHAPi reported that some hospitals have received summonses from the National Bureau of Investigation concerning their claims.
PhilHealth received 35,147 COVID-19 claims from hospitals in 2020 but only 10,265 of the claims were paid, amounting to P2.5 billion.
Of the 2,859 claims for critical COVID-19 cases, PhilHealth only paid 642 claims or P505.6 million. It refused to pay for 309 cases amounting to P243 million. PhilHealth returned 1,179 claims of hospitals for critical cases costing P927.15 million and 729 claims for critical cases were still under process as of July 31, 2021.
For critical COVID-19 cases, PhilHealth ought to have shouldered P786,384 of a member’s hospitalization.
The 2019 COA report had concerns on PhilHealth’s actuarial estimates and assumptions and sought an improvement in its actuarial valuation process.
“We at the Senate need to examine PhilHealth’s finances and take that into consideration in the discussions for the 2022 government budget,” Poe said.
“Before COVID-19, COA already had concerns on PhilHealth’s actuarial valuation process. COVID-19 would have made it more urgent for PhilHealth to get an actuarial study of the fund to come up with a set of recommendations that would make the fund viable and sustainable,” Poe added.
